Healthcare Provider Details

I. General information

NPI: 1508334293
Provider Name (Legal Business Name): EMILY LANE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2018
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SOCIETY ST
ANDERSON SC
29621-5637
US

IV. Provider business mailing address

215 SOCIETY ST
ANDERSON SC
29621-5637
US

V. Phone/Fax

Practice location:
  • Phone: 864-237-4299
  • Fax: 864-661-9195
Mailing address:
  • Phone: 864-237-4299
  • Fax: 864-661-9195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22382
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: